Provider Demographics
NPI:1437318243
Name:GNAS, LISA RENE (DO)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:RENE
Last Name:GNAS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 N CANTON CENTER RD STE 181
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2651
Mailing Address - Country:US
Mailing Address - Phone:877-882-4800
Mailing Address - Fax:
Practice Address - Street 1:5820 N CANTON CENTER RD STE 181
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2651
Practice Address - Country:US
Practice Address - Phone:877-882-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013946207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5101013946OtherMICHIGAN LICENSING AND REGULATORY AFFAIRS